System for enhancement of neurophysiological processes

ABSTRACT

Treatment apparatus and method for the enhancement of neurophysiological processes of a patient&#39;s visual system utilizes a computer generated display that provides a patient simultaneously with passive visual stimulation images and visual cognitive exercises. The stimulation images include moving elements having edges or points of contrast. The exercises include visual and phonological elements. The invention is used to treat reading, writing and speech disorders, and attention deficit hyperactivity disorder, as well as having broader applications for example in sports sciences.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/018,733, filed on Mar. 11, 2003, which is a national phase entryunder 35 U.S.C. § 371 of International Publication No. WO 00/77760,published Dec. 21, 2000, which claims the benefit of AU PatentApplication Nos. PQ2183, filed Aug. 13, 1999 and PQ0933, filed Jun. 15,1999, the disclosures of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

This invention relates to a system for the enhancement of theneurophysiological processes of a person, in particular those processesassociated with reading, writing and speech. The invention was conceivedin the context of treating reading, writing and speech disorders but hasfar broader applications including the treatment of Attention DeficitHyperactivity Disorder (ADHD) and the enhancement of a person'sperception of movement required for example, by sportspeople or defenceforce personnel.

Since the late nineteenth century it has become increasingly noticeablethat a substantial percentage of the population possess no abnormalitiesin conventional vision, hearing or intelligence, yet displaydebilitating disorders of reading, writing and speech.

Although there is a connection between these different types ofdisorders, reading disorders have attracted the most concern andattention and are thought to afflict up to 15% of the world'spopulation. Reading disorders are psychologically and economicallydamaging to a person, are largely hereditary and have been considered tobe incurable.

A growing body of neuroscientific research has linked many of suchdisorders with neural debilitation's in different areas of the brain.

Several groups of scientists utilising modem non-invasive diagnostictechniques such as functional Magnetic Resonance Imaging (fMRI) orPositron Emission Tomography (PET) have found significant differences inbrain activity, in particular in areas of the brain associated with theperception of movement, between those with reading disorders and thosewithout.

The perception of sight begins when visible light contacts the retina atthe back of the eye. Photoreceptor cells known as rods and cones arestimulated by this light to produce electrical impulses. These impulsestravel from the retinal ganglion cells via their axons and ultimatelyconnect with the visual centres of the brain, in particular the visualcortex. The connection between the retina and the visual cortex includesa small midbrain nodule called the lateral geniculate body. This body isdivided into two layers, one of which is part of the magnocellularpathway and the other a part of the parvocellular pathway. The dividedsignal from these visual pathways continues to the visual cortex and theextrastriate visual cortex at the back of the brain to undergo amultiplicity of complex processes to emerge as a perception of sight.

The magnocellular and parvocelluar systems are part of theretino-geniculo-cortical pathway system. The magnocellular pathway hasevolved to be able to process rapid movements of low contrast images inconditions of low luminance but with relatively poor colour sensitivity,whereas the parvocellular pathway processes fine stationary detail inconditions of brightness and with greater colour sensitivity.

Research has shown that both pathways are parallel processing systemsinvolved in developing and sustaining an acute kind of depth perceptioncalled stereopsis. The magnocellular system is responsible for motionstereopsis, which is vital for normal reading. The parvocellular systemis responsible for static stereopsis. Deficiencies in either pathway canaffect stereopsis which can lead to an inability of a person to properlyprocess visual images.

Furthermore, it has been suggested in some research that thedebilitation of receptive cell fields in the magnocellular pathwaycauses this parallel processing system to deliver mistimed visualinformation to the visual cortex. This, it has been hypothesised, causesinstability of viewed text in some patients resulting in their readingdisabilities.

The visual system is predominantly edge seeking and motion biased incharacter. Holding a steady fixation on a visual target is indeed notpossible. When a steady fixation is induced in a laboratory, the visualimage fades.

Oculographic recordings have demonstrated three types of eye movementsthat occur during fixation: microsaccades, (small, high-speedadjustments of fixation), fixation drift and high frequency tremors.

Saccades used in normal vision bring items of visual interest into thefoveal area of the retina for examination under conditions of maximumacuity. Microsaccades are similar to saccades, except that theamplitudes are smaller.

Microsaccades occur about 2 to 3 times per second, along with a slowfixation drift, which in combination prevent fading of the retinalimage. The manner in which microsaccades and fixation drifts areinterposed is dependent upon an individual's optokinetic control. Suchcontrol is in turn influenced by neurophysiological debilitations thatare partially non-visual in source.

Oculographic recordings have shown that during reading a stereotyped“staircase” pattern of eye movements occurs, consisting of alternatingsaccades and periods of fixation. During the pauses, semanticidentification and recognition of characters is thought to occur. Eachsaccade moves the fovea (the portion of vision with the greatestacuity), about eight characters to the night. At the end of a line, alarge saccade to the beginning of the next line occurs and the behaviouris repeated.

An optokinetic deficit could lead to reading disorders if it preventsmicrosaccades from occurring at the required speed and endurance, and ifit prevents fixation drift to be controlled with enough endurance. Ifthis deficit is compounded by some language or phonological impairment,then semantic recognition, an essential link in the reading chain, canbe even more difficult to achieve.

During more rapid normal reading or the normal viewing of more complexvisual images, the eyes employ a healthy motion and static stereopsis(depth perception) to find visual ‘cues’. They pause at very small timeintervals and look directly at what the brain considers are the moreimportant visual elements and deduces what is in between.

It has been suggested that some normal readers employ a strategy thatuses “habitually preferred” patterns stored in their memory. Thisinvolves an initial visual scanning phase described as to “look withoutseeing” in which an internal model is formed in order to then “secwithout looking”. Finally, there is a rapid model verification phase to“look and see”. This requires rapid saccades to move the high acuityarea of the fovea to the salient features for verification.

An ability to provide the required saccades, control of fixation drift,recognition of semantics, stereopsis and an adequate visual workingmemory, are essential prerequisites for good reading.

Furthermore, because of the relationship within the brain of themagnocellular and parvocellular pathways with other neurophysiologicalprocesses such as speech, hearing and kinaesthetic and somatosensoryprocesses, an inability to properly process visual images can lead todisorders in these other processes.

From the large numbers of reading disorder treatment providers, few haveattempted to search for curative solutions, particularly based on visualcauses, in the belief that cures are not possible. Indeed most readingdisorder associations and much of the scientific community still supportthis view.

The beginnings of a visual based curative approach commenced with thedevelopment of a simple apparatus called the CAM visual stimulator,developed in Cambridge England in the mid 1970s. The CAM stimulator wasdeveloped not for the treatment of reading disorders, but for theorthoptic treatment of pathologic binocularity, a condition wherefixation errors of the eyes cause the brain to favour signals from adominant eye and tends to suppress signals from the weaker eye. Thestimulator comprised rotating paper discs covered with painted gratingsintended for visual stimulation. This apparatus gained wide interest andexposure for the orthoptic treatment of ocular fixation disorders butwith limited success.

Another version of the CAM apparatus was developed in Australia in thelate 1970s, and comprised similar rotating discs with painted gratings,but with the addition of a diffuse light source from between thegratings. This second version of the CAM apparatus was the subject ofAustralian patent application no. 70697/81 by A.M. Lawson. It was alsoconceived and originally used for the same treatment of pathologicbinocularity, although later was used for treatment of visual dyslexia.

Whilst these prior art apparatus achieved some success in treating thefixation disorders for which they were designed, their success intreating reading disorders was limited due to the complex nature of theretino-genicular-cortical pathways and the very limited range ofstimulations that the rotating discs could provide. The edges of thestripes that provided the visual cues to the patient had a constantlocus of movement, that being a circular path, and only provided thecorrect stimulation to a limited number of cells in the visual cortexand for a brief period of time as the edge passed through a particularorientation. The only variation in the stimulation was achieved bychanging the disc to one with a different spacing and width of stripes.This variation could not be achieved without disruption to the patient'streatment.

The present invention seeks to provide apparatus and method wherein apatient can receive a more complete set of stimulations than waspossible with the prior art.

SUMMARY OF THE INVENTION

In a first aspect, the invention resides in apparatus for theenhancement of neurophysiological processes of a patient including firstvisual display means for viewing by said patient and computer processingmeans producing an output to said visual display means to cause adisplay on said display means, said display including at least onevisual cognitive exertion exercise and at least one visual stimulationimage including a plurality of moving visual display elements, whereinsaid visual stimulation image is capable of providing visual stimulationto a patient whilst said patient is performing said cognitive exertionexercise.

The invention also resides in a method of enhancing neurophysiologicalprocesses of a patient including the steps of generating an output fromcomputer processing means to cause a display on visual display means,said display including at least one visual cognitive exertion exerciseand at least one visual stimulation image including a plurality ofmoving visual display elements, wherein said visual stimulation imageprovides visual stimulation to said patient whilst said patient isperforming said visual cognitive exertion exercise.

The present invention can provide many benefits to a patient notpossible with the prior art treatment systems including a visualstimulation image that can be varied to provide the stimulation requiredby the patient and in particular can be varied without a discontinuityin the patient's treatment. Furthermore the visual display elements canbe generated as direct light objects which are far more effective instimulating the cell fields of the retino-geniculo-cortical pathwaysystem than the diffuse light sources from between the rotating striateddiscs of prior art.

In a further embodiment the invention resides in apparatus for theenhancement of neurophysiological processes of a patient including firstvisual display means for viewing, by said patient and computerprocessing means producing an output to said visual display means tocause a display on said display means, said display including at leastone visual cognitive exertion exercise and at least one visualstimulation image including a plurality of moving visual displayelements, wherein said visual stimulation image is capable of providingvisual stimulation to a patient whilst said patient is performing saidcognitive exertion exercise and wherein said apparatus includes meansfor varying at least one, and preferably at least two, of spatialdensity, luminance, contrast, colour, shape, velocity and locus ofmovement of said plurality of visual display elements.

In a further embodiment, the invention resides in apparatus for theenhancement of the neurophysiological pathways of a patient includingfirst visual display means for viewing by said patient and computerprocessing means producing an output to said visual display means tocause a display on said display means, said display including at leastone visual cognitive exertion exercise and at least one visualstimulation image including a plurality of moving visual displayelements moving in a substantially linear path, wherein said visualstimulation image is capable of providing visual stimulation to apatient whilst said patient is performing said cognitive exertionexercise.

In a still further embodiment, the invention resides in apparatus forthe enhancement of the neurophysiological pathways of a patientincluding first visual display means for viewing by said patient andcomputer processing means producing an output to said visual displaymeans to cause a display on said display means, said display includingat least one visual cognitive exertion exercise and at least one visualstimulation image including a plurality of moving visual displayelements, wherein said visual stimulation image is capable of providingvisual stimulation to a patient whilst said patient is performing saidcognitive exertion exercise, said apparatus further including means forgenerating an auditory cognitive exertion exercise including one or moreauditory signals related to at least one of said visual cognitiveexertion exercises.

In yet a further embodiment, the invention resides in apparatus for theenhancement of the neurophysiological pathways of a patient includingfirst visual display means for viewing by said patient, computerprocessing means producing an output to said visual display means tocause a display on said display means and patient input means, saiddisplay including successively displayed patient-interactive visualcognitive exertion exercises and at least one visual stimulation imageincluding a plurality of moving visual display elements, wherein saidvisual stimulation image is capable of providing visual stimulation to apatient whilst said patient is performing a displayed cognitive exertionexercise and wherein a next cognitive exertion exercise is displayed inresponse to an input from said patient.

The visual display elements may be anything capable of stimulating thereceptive cells fields along the neurophysiological pathways of apatient, but will typically comprise some form of points or edges ofcontrast or picture elements containing points or edges of contrast.

A particular advantage of the present invention is that it provides themeans to vary the visual stimulation image(s) whilst the patient isperforming a cognitive exertion exercise. This ensures that as many ofthe receptive cell fields of the patient as are necessary or possiblereceive adequate stimulation. The changes to the visual stimulationimage can be made abruptly by displaying a fresh image or can be made tooccur by graded changes so that a dynamic, constantly evolving visualstimulation image is displayed. The changes can all occur withoutdisrupting a patient's focus on the cognitive exertion exercise thepatient is performing. The variations that can be made include changesin the colour, shape, contrast, luminance, spatial density, velocity orlocus of movement of the moving visual display elements.

In a preferred embodiment, the invention further includes means forproviding a different visual stimulation image to each eye of a patientand/or means for occluding one of a patient's eyes from the display. Inthis embodiment, the level of occlusion may be varied.

In a further preferred embodiment, the invention includes a secondvisual display means to be viewed by a therapist and therapist inputmeans allowing a therapist to provide inputs to the computer processingmeans to vary the display.

In yet another embodiment, the invention includes feedback meansproviding feedback of a patient's performance to the computer processingmeans and preferably includes means for altering the display in responseto said feedback in order to optimise a patient's performance.

The invention will now be described by way of example only and withreference to the accompanying figures as described below.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of the apparatus of the present invention,

FIG. 2 shows a side view of apparatus according to the invention,

FIG. 3 shows a display of a visual cognitive exertion exercise andvisual stimulation image,

FIG. 4 is an example of predominantly non-cortical stimulation elements,

FIG. 5 is an example of predominantly cortical stimulation elements,

FIG. 6 shows curvilinear elements,

FIG. 7 shows a brick pattern of elements,

FIG. 8 shows two rotating planes of stripes in a first orientation,

FIG. 9 shows the stripe planes of FIG. 8 in a second orientation,

FIG. 10 shows the stripe planes in a third orientation,

FIG. 11 shows the stripe planes in a fourth orientation,

FIG. 12 shows the different images generated by the rotating stripeplanes,

FIG. 13 is an example of a cognitive exertion exercise,

FIG. 14 shows an alternative embodiment of the present invention,

FIG. 15 shows a cognitive exertion exercise incorporating an auditorycomponent,

FIG. 16 is a second auditory cognitive exertion exercise, and

FIG. 17 shows a flow chart for treatment according to the invention.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

With reference to FIG. 1, apparatus according to the invention is showngenerally at 10 and includes a computer processor 11, a patient console18 including a patient visual display unit (VDU) 12 and patient inputmeans 16, and a therapist console 19 including a therapist visualdisplay unit 13 and therapist input means 17. A patient 14 is shown atthe patient console 18 whilst a therapist 15 is shown at the therapistconsole 19. The position of the patient console 18 is such that apatient 14 is unable to view the VDU 13 of the therapist console whilstviewing the patient VDU 12. In the case of the patient console shown,the patient input means is an electronic writing pad whilst thetherapist inputs information via a conventional keyboard 17.

In FIG. 2 an alternative arrangement is shown wherein the patient 14 isseated on an electronically adjustable seat 21 that can be moved up anddown as well as laterally. The headrest 22 and backrest 23 can also becontrolled to ensure the location of the patient's eyes relative to thepatient VDU 13. The seat controls, including the controls for theheadrest and backrest form part of the therapist console 19. A patient'spositional settings may be stored in the computer processor to provideconsistency at subsequent treatment sessions.

The therapist 15 is presented with the same display as the patient andis able to control the parameters of the treatment. A comparison of howthe patient has progressed and how the patient relates to those withsimilar disorders is also available for viewing by the therapist.

An exemplary display to be provided on the patient VDU is shown in FIG.3 and includes a plurality of inclined stripes moving in a linear pathacross the display unit in the direction of arrow A. Moving in theopposite direction as indicated by arrow B is a cognitive exertionexercise comprising words or phrases which a patient must remember andwrite down after they disappear, or select and form into a sentence.Thus the exertion exercise can improve or enhance other aspects of apatient's neurophysiological processes such as working memory whilstfocussing the patient's attention onto the display to ensure theyreceive the visual stimulation from the moving elements.

Furthermore, the present invention allows a multitude of visualstimulation images to be presented to a patient without disruption tothe patient's treatment and allows variations within those images to bemade to maximise the benefit that a patient receives. For example in theabove described display of FIG. 3 the stripe width and spacing can beadjusted by simple inputs from the therapist as can the colour,contrast, direction etc of the stripes. Non-cortical stimulationelements can also be added as described below. In this way a therapistcan ensure that as many receptive cell fields as possible along theretino-genicular-cortical pathway are properly stimulated.

It is an objective of the present invention to stimulate as manyreceptive cell fields as is possible, that are involved in processingthe type of vision that is required for reading and for the perceptionof movement.

The beginning of the retino-geniculo-cortical pathway is the retina,which contains a large number of different cell types, such as ganglioncells, horizontal cells, bipolar cells and amacrine cells. Within eachtype there are numerous subtypes. These are organized in a remarkableconcentric configuration. Hence stimulation of these by light requirespots and annuli of light. The response of these is highly variable,depending upon whether the centre spot is stimulated only, or theannulus, and whether the centre and annulus are stimulatedsimultaneously. Varying the width of the annulus also influences theresponse.

The excitation that the stimulation produces in these cells is alsodifferent according to cell type. For on-centre cells, the field centreis excited by light stimuli, whereas the surround is inhibited by lightstimuli and excited by dark stimuli. For off centre cells the reverse istrue.

From some cell types, excitation is either on or off, or tonic, and issustained. For others it is transient, or phasic, meaning it isproportional to the stimulation.

The maximal response is obtained by choosing a spot size equal to thediameter of the receptive field centre. If the spot is larger, then theresponse is attenuated, indicating antagonism between the centre and thesurround subfields.

Cells in the lateral geniculate body are similar to that of the retinabut with differences in response. The surround of geniculate cells isrelatively more effective at cancelling the centre, making geniculatecells even less responsive to the illumination of the entire receptivefield.

The parvocellular and magnocellular pathways from the retina remainsegregate at the lateral geniculate body. Their respective cell fieldshave their particular stimulation requirements.

The most common type of parvo cell has a standard centre-surroundreceptive field arrangement, where the centre and the surround havedifferent spectral sensitivities. A typical such cell might give an ‘on’response to a red spot and an off response to a green anulus. A secondtype of parvo cell provides a response to coloured light wherever it isapplied in the receptive cell field. A third type is similar to thesecond type except that the receptive cell field is indifferent tocolour wherever it is applied.

The majority of magno cells are indifferent to colour and havecentre-surround receptive fields, similar to the third type of parvocell above. Another type of magno cell however, does have the unusualbehaviour of responding with a dramatic, prolonged silence to a largered spot.

A stimulation image as shown in FIG. 4 is appropriate for stimulation ofthe concentrically organised cell fields in the visual pathways beforethe visual cortex and in some cases beyond. The image consists of annuliand dots of different dimensions and colour combinations, designed tomatch the particular cell sizes and characteristics of these cellfields. The dots and annuli are shown in FIG. 4 together with aplurality of stripes that may form part of the cortical stimulationdescribed below. At the interface where a stripe meets a boundary of thedot or annuli, a contrast change occurs. Relative movement between thedot and the stripe creates a dynamic stimulation as the size of aparticular contrasting feature changes. It is preferred that at leastsome of the annuli/dots move randomly to provide contrast boundariescovering the full range of dimensions and directions. The centre dot isapproximately 15 mm in diameter with a surrounding annulus ofapproximately 25 mm, though the dimensions may be varied to correspondand provide stimulation to different receptive cell fields.

The proper utilisation of this image requires particular management notto conflict width the cognition exertion exercise, particular where theexercise includes fragmented tasks where objects in the exercise areobstructed by the moving elements of the stimulation image. Hence a highdegree of adjustability and choice is incorporated in this image.

There is an automatic contrasting feature that allows dots and annuli topass through any opaque object and instantaneously switch contrasting sothat there are always dark edges or the patient to look at.

There is a density selection feature, which enables several dot/annulidensity combinations to be chosen, either uniformly across the viewfield of the monitor, or in random appearing clusters, or with a centredisplay view bias. This selection can be performed by a therapist inresponse to either passive or active feedback from the patient in orderto maximise the stimulation to the patient, or to concentrate onspecific receptive cell fields. Alternatively, computer software can beused to make progressive adjustments to the spot/annuli size and densityto ensure that the full range of stimulations are provided.

Once an adjustment has been made, the computer software can ensure thatevery position in the view field has been occupied by a moving elementcomprising an annuli and a dot of particular dimension and colourcombination, before the software automatically makes a progressiveadjustment for the next size element.

The end of the retino-genicular-cortical pathway is the visual cortex.The visual cortex has been divided into more than thirty functionalareas that have so far been identified. The areas that process theincoming signal first have been designated as V1, V2, V3, V4 & V5.

V1 transfers visual information from the magnocellular and parvocellularsystems to V2. This is consistent with research findings that V2 has ahigh proportion of both colour sensitive and motion sensitive receptivecell fields. Furthermore, the connection of both pathways also suggeststhat V2 plays a part in both motion and static stereopsis.

V1 also sends magnocellular visual information to V3, which containsmainly motion sensitive receptive field cells, but few if any, coloursensitive cells. It is therefore likely that V3 participates mainly inmotion stereopsis.

V4 contains largely colour sensitive receptive cell fields which areused to process colour, after the visual information regarding colourhas already been processed by V1 and V2.

V5 is referred to as the middle temporal area. The striking aspect aboutV5 is that almost all the receptive cell fields are sensitive to bothdirection and motion, as well as to eye movement. Some of these cellsare indifferent to stimulus shape and are particularly sensitive to thedirection of that motion. Hence there is a major magnocellularprojection from V1 to V5.

There are therefore three separate but interconnected pathways throughV1, V2, V3, V4 & V5. A first pathway sends mainly parvocellular visualinformation from V1 to V2 to V3. The second pathway takes mainlymagnocellular visual information from V1 to V2 and then onto V5, whilethe third runs both magnocellular and parvocetlular visual informationfrom V1 to V2 and then to V4.

The cells of the visual conex are different to those encountered at theretina or lateral geniculate body and are classified in terms of simplecells, complex cells, and their receptive field hierarchy.

Simple cells can be described by their response to a single spot andwhether it is excitatory or inhibitory. They exhibit summation withintheir separate excitatory and inhibitory subfields and antagonism whenboth regions are stimulated simultaneously. In this respect, simplecells are similar to the centre surround cells of the lateral geniculatebody. The critical distinction is that the geniculate cells areconcentrically arranged, whereas the cortical cells are organised intoparallel, flanking subfields, separated by straight boundaries.

The geometry of the subfields varies considerably among simple cells.However, for all simple cells, the best stationary stimulus is a slit orbar of light exactly the right dimensions to activate only an excitatoryor on response, or an inhibitory or off response.

Correct orientation of the stimulating bar is crucial to obtain themaximum response. If the stimulating bar is not parallel to the axis ofthe receptive fields, it will stimulate part of the inhibitory subfieldand fail to stimulate the entire excitatory subfield. Orientationselectivity is an essential feature of cortical simple cells. Allorientations are represented equally in the visual cortex.

Simple cells respond briskly to moving bars, slits or edges and usuallyfire a bust of spikes just as a moving light bar enters an excitatoryregion. The most vigorous discharge is provoked by simultaneouslyleaving an inhibitory zone and entering an excitatory zone. Cells with asymmetric subfield arrangements generally given an equal response tomovement in either direction. Cells with asymmetric subfields often giveunequal responses to movement in the opposite direction. The optimalspeed of stimulus movement can also vary among simple cells.

Complex cells cannot be categorised with stationary stimuli intoexcitatory and inhibitory sub regions. They give inconsistent on-offresponses when tested with stationary slits or spots of light. However,when a light slit is swept across the receptive field, it elicits asustained barrage of impulses. A complex cell may respond to movement ofthe light stimulus anywhere within the receptive field, provided thestimulus is oriented correctly.

Ordinary complex cells show summation by responding more robustly as thelength of a light stimulus is increased. The maximum response occurswhen a slit or bar equals the full length of the cell's receptive field.Extending the stimulus beyond the length of the receptive field augmentsthe response no further.

Receptive cell fields in V5 respond well to a light spot, bar, or slitmoved briskly in a preferred direction, and give no response to anopposite direction. For these cells, the stimulus shape matters littleas long as the direction of the movement was correct. Other cells in V3required a properly orientated slit or bar moved in a certain direction.The receptive cells in V5 resembled those in V1 except those in V5 wheremuch larger and are direction selective.

A simple linear omni-directional image for stimulating receptive cellfields in the visual cortex is described with reference to FIG. 5. Thisfigure shows a plurality of parallel inclined stripes approximately 11mm wide that move in a linear path in a direction transverse to thelongitudinal direction of the stripes as indicated by arrow A. Thestripes move in their path with a sinusoidal velocity with an averagespeed of approximately 75 mm per second. A background rotation asindicated by arrow B is imposed to change the locus of movement of thestripes and ensure that all orientations of the edges are displayed tothe patient. The rotation is effected stepwise by rotating the plane ofstripes 2° every 5 seconds. Once the plane of stripes has been restatedthrough 180° so that all orientations have been displayed, the stripewidth and spacing is adjusted, preferably in increments of approximately0.5 mm, and the rotation repeated.

A variation of the stimulation image of FIG. 5 is shown in FIG. 6 a.This image shows a plurality of parallel curvilinear stripes that movewith the same linear and rotational movement characteristics asdescribed for the straight edged stripe embodiment discussed above.However, a further movement with sinusoidal velocity is introduced inthe direction of arrow C. FIG. 6 b shows an image with non-parallelcurvilinear stripes moving similar to the stripes in FIG. 6 a. Thenon-parallel pattern produces ‘globules’ which travel in a directiontransverse to the direction of the stripes. Non-cortical stimulationelements as described above can be placed in the regions between thestripes. These elements can be put into motion relative to the globulesand made to behave in a varying manner, for example by accelerating theelements as they move through the narrow necks between the stripes.

A further variation of the linear moving edge stimulation image is shownin FIG. 7. The image is presented as a brick wall pattern which includesmovement characteristics as for the previously discussed images. Theadvantage of this image is that the provision of brick ends in astaggered configuration provides a further series of moving edges. Analgorithm that is a part of the computer software takes account of imageparameters chosen by the therapist during treatment. The length to widthratios and the orientation to direction ratios are progressivelyadjusted so that a patient can receive a full range of stimulations in ashorter time frame than is possible for the above described series ofstripes. The variation of stimulation images as shown in FIG. 7 isparticularly suitable for use with orientations moving in directionsthat are not transverse to the longitudinal direction of the bricks, asrequired by some cell fields, particularly in V5. The brick pattern maybe used at an orientation angle approaching or equal to a horizontaldirection of motion whilst still revealing an underlying cognitiveexercise, which is not possible with the above described stripepatterns.

FIGS. 8 to 12 show a ‘Diamond Multi-edge’” stimulation image designed tostimulate various portions of the visual cortex. The image was conceivedas a means of providing the maximum number of moving edges of alldimensions, orientations, directions and velocities in a given timeframe, for the maximal stimulation of the motion, velocity andorientation sensitive layers of the visual cortex and the extrastriatecortex. The image is formed from two overlying planes of stripesrotating relative to each other.

FIG. 8 shows a ‘snapshot’ of when the two striped rotating fields arehorizontal and exactly over one another. The stripe width and spacing isequal in this example. The stripe fields rotate in opposite directionsabout an axis at the centre of the monitor vision field andperpendicular to it. Both rotating fields are part of a field whichitself rotates.

FIG. 9 shows the display after striped planes have rotated just a fewdegrees. Diamond shapes appear that move towards the axis of therotation.

FIG. 10 shows the display with further rotation than FIG. 9. The diamondshapes are more numerous and more ‘squat’.

FIG. 11 shows the display when the stripe planes are at 45 degrees. Thediamond shapes are more numerous and with sides of equal length.

FIG. 12 shows a series of shapes created during the ‘Diamond Multi-edge’stimulation image. The shapes shown are those created between a pair ofstripes starting as in FIG. 8 (FIG. 12 a). The rectangular shape rapidlybecomes a diamond shape (FIG. 12 c) which progressively becomes morecompact (FIG. 12 d), and is joined by other diamond shapes. Thedirection of motion of the diamonds relative to the reference plan iseither a horizontal straight line, (starting as in FIG. 8) stationary atthe 45 degree point as in FIG. 11 then switching to vertical motion. Atthe 90 degree rotation point, the display appears as in looks like FIG.8 but vertical.

A slow rotation of the reference screen keeps altering the point atwhich FIG. 8 is seen. The computer software causes a background rotationof the entire reference plane so that the rectangles as in FIG. 8 areseen at every orientation within 360 degrees within a given treatmentperiod.

It will be noted that the motion of the corners of the diamonds issubstantially linear apart from the background rotation which causes abarely perceptible curve in the motion.

The present invention allows for the wavelength or colour of the stripesto be adjustable. With the appropriate selection of colour combinations,it is possible to create the visual conditions where the eye perceivesthe lines where the stripe of one plane crosses the other as ‘edges’.This introduces a further large number of edges.

The rotational velocities of the stripes can be made non-linear andcyclic to ensure that every receptive cell field that is sensitive toparticular velocities and orientations are stimulated within a treatmentsession in which the reference plane has rotated through 360 degrees. Itis possible that parallel curvilinear stripes are used instead ofrectangles so that more complex diamond shapes are generated.

As discussed previously, all cells can be stimulated with light or nolight. It can be seen from a description of the cell types, that for astimulation image to be effective, it needs to match the greatly varyingcharacteristics of those cells. In the retino-geniculo portion of thepathway, the stimulation needs to be a mixture of dots, annuli andcolours, with appropriate motion, timing, dimensions and contrasts. Inthe cortical portion of the pathway, there needs to be a stimulationregime with predominantly moving edges, bars, slits, shapes, with anappropriate motion, direction, velocity, dimensions, contrast as well asa dot regime as described above.

All of the characteristics of stimulation, need to be variable toaccommodate the different dimensions, motions, velocities direction,time of exposure, colour requirements, contrast, luminance and viewingdistance. No device in prior art has either the ability to provide thefine and varied adjustment required, or seeks to stimulate the receptivecell fields of the retino-geniculo-cortical pathway or beyond, as doesthe present invention.

When the stimulation regime based on cell characteristics is being usedfor treatment of the visual system, it will mostly be presented as amoving background to the interposed cognitive exertion regime, which isintended to be the focus of attention for the patient.

The interposed cognitive exertion regime is designed to ensure that thepatient's eyes will be exposed to the background stimulation regime as amixture of peripheral vision and direct vision. For this reason, thebackground stimulation could be thought as ‘passive’, in that it iscapable of stimulating the cells without conscious effort on the part ofthe patient, in a similar way that electrical stimulation can contractand stimulate muscles. On the other hand, the interposed cognitiveexertion regime is designed to force the concentration or the patientand think more deeply about the tasks that are presented.

FIG. 13 shows an example of a stationary cognitive exertion exercisecomprising a ‘master board’ of mosaics displayed on one half of thecomputer screen. A blank mirror image of the ‘master board’—the ‘targetboard’—is seen on the other half of the screen.

A passive background stimulation regime passes under the master boardbut over the target board. The stimulation image shown in this drawingis the linear omni-directional image.

The patient is required to ‘click’ on a dark mosaic on the master boardto produce a copy, which then needs to be dragged to its mirror positionon the target board. If the patient ‘clicks’ the correct position on thetarget board, the copy stays there. If not, the mosaic returns to itsoriginal place on the master board, registering an error.

A running score is kept to track the patient's performance. In thisdrawing, the time taken by the patient to fully complete the exercise isseen in digital form on the screen and is recorded. The objective ofthis treatment is for the patient to have a pass by the end of the lastsession at the degree of difficulty appropriate to the patient.

The degree of difficulty in this exercise can be adjusted in stages bythe therapist or can be adjusted automatically by the computer softwareif the feedback from the patient indicates that an adjustment isnecessary, either because the patient's performance is good, or thepatient is having difficulty comprehending the exercise.

The blank target board can be made to move in a direction opposite tothe moving stimulation background, constantly reappearing. Hence thepatient is forced into greater visual effort by having a moving targetand limited time.

A further stage of difficulty is achieved by reducing the contrast ofthe master and target boards. This places greater demands on themagnocellular pathways, which are debilitated in those patients withvisually caused reading disorders.

This exercise is usually followed by a semantic version of it, whereevery square in the master and target boards is covered by cololuredmosaics. The master board mosaics cover sentences or phrases. If thecorrect position on the target board is chosen, a letter is revealed onthe corresponding position of the master board. If not, the mosaicreturns to the master board without uncovering a letter. The objectiveis for the patient to be able to read the sentence or phrase with someletters covered. Every letter covered earns the patient points, whichare accumulated.

This semantic version of this exercise helps enhance the patient'sreading ability by improving short-term visual working memory and thepatient's ability to construct whole words and phrase from fewer visualcues.

Both the passive and active stimulation regimes are specificallydesigned to expand working visual memory and enhance greater semanticrecognition and recognition speed. This is achieved by fragmenting thevisual and semantic tasks into moving elements and passing themunderneath some of the opaque background stimulation elements. This isalso achieved by passing the opaque background stimulation elements overstationary tasks or puzzles. The tasks are therefore seen periodicallyfor short periods of time thus forcing the patient to remember shapesand portions of words long enough to be able to reconstruct them beforethey disappear from the screen. The complexity of the tasks and the timeavailable for their completion can be progressively adjusted throughoutthe treatment to ensure that the patient is constantly improving.

A further embodiment of the invention is described with reference toFIG. 14 in which a patient receives both visual and auditorystimulations. In the embodiment shown, the patient visual display unitis a pair of virtual reality goggles connected to the computer processorto receive the display images. The patient also wears a set ofheadphones for receiving auditory signals. The goggles and headphonesmay be integrated into one piece of headwear such as a helmet. Theapparatus shown may further include microphones and recording devicesfor receiving spoken responses from the patient, and speech recognitionsoftware in the computer processor for suitably processing the patient'sspeech.

Those diagnosed with auditory and phonological impairments will bepresented with aural tasks consisting of sounds and speech. These auraltasks will relate to visual elements on the monitor that will bepartially seen between a visual stimulation background that is chosenand adjusted to suit the patient. The patient response will be a mixtureof the spoken, the written, the drawn and the visual. Working memoryenhancement will therefore be simultaneously auditory and visual.

The aural task may be a simple task as shown in FIG. 15 where text isinitially presented to the patient aurally before it is displayed on thescreen. The patient will need to correctly interpret the combination ofphonemes making up the originally presented words and make a correctauditory semantic recognition of the words, phrase or sentence. Thisrecognition needs to reside in the patient's auditory working memory.The text will then appear in visual form and move underneath the passivestimulation elements. The patient will need to make semantic visualrecognition from the bits and pieces of words passing between the spacesof the background, and put them together in a phrase or sentence beforethey disappear off screen.

A further example of a combined aural/visual cognitive exertion exerciseis described with reference to FIG. 16. In this figure, a series ofauditory exertion exercises are shown. A cognitive exercise is presentedaurally to the patient when there is nothing on the screen except anactive linear omni-directional visual stimulation regime, adjusted for apatient with a ‘phonological bias’. Only after the aural input has beenmade, the visual cognitive exercise corresponding to that input appears,requiring the patient to remember what has been said and to respondaccordingly.

The exercises given are selected from an archive that is categorised bygender, race, and cultural background. Language is modified to beregionally appropriate with respect to idiom and accent. Exercisesinvolve phonemes of difficulty particular to the patient can beselected.

Responses are to be made by the patient who is able to look at thescreen and indicate a response by pointing to an object using a stylusheld as a writing instrument on an electronic work tablet. Objects aredragged in accordance to the aural instructions, without the patienthaving to take his or her eyes off the computer screen. For example, forthe exercise depicted in FIG. 16, an auditory input is provided to thepatient in the form.—

“Benjamin is a happy boy”

“Harold is unhappy”

“Match the name with the face by dragging a name over the face”

The image in FIG. 16 then appears on the screen and the patient has toperform the spoken task.

Incorrect responses, if dragged to the correct subject, will return bythemselves to their pre-programmed paths with an error recorded by thesystem against the patient. An incorrect response dragged to anincorrect subject will be recorded as two errors.

A database of the computer processor will keep a record of the patient'sresponses to treatment as a means of assessing rates and degrees ofpatient improvement.

For each of these exercises involving a speech input the speech will bepresented with the spectral content of normal speech but with anelectronically modified temporal content to provide more time for thepatient to recognise the different phonemes they are unable to recognisein unmodified speech. The temporal component can then be adjusted as thepatient improves to increase the speed of the speech inputs withoutmodifying their sound.

It is of particular importance for those with reading disorders toacquire a healthy stereopsis through sound binocular vision. Fixationproblems at an early age can lead to one eye dominance and to thedebilitation of the other eye. This would include the debilitated eye'smagnocellular pathways, the debilitation of which could cause visiontiming problems as previously discussed. There can also be a diminishedability to perform microsaccades and to control fixation slip that couldlead to less accurate symbol identification and semantic recognitionproblems.

An important element in the treatment of reading disorders according tothe present invention is the restoration and maintenance of binocularitythroughout the treatment. This can be achieved through normal orthopticprocedures that involve initial occlusion following by a coloured lensfiltering of the dominant eye as is known from prior art treatments ofocular fixation disorders. However, the present invention is well suitedto make use of new display technologies such as virtual reality gogglesand direct retinal imaging to provide varying levels of occlusion. Inparticular, these technologies can be used to display the same image toeach eye with modifications to be viewed by one eye only, oralternatively a separate image can be displayed to each eye.

FIG. 17 shows a treatment flow chart in accordance with the invention.The first stage of a patient's treatment is diagnosis by conventionalmeans to determine the debilitation profile of the patient and inparticular whether the patient's disorders are predominantly visuallycaused or phonologically caused. After diagnosis, the patient'streatment can proceed down either the visual or phonological treatmentstreams depending on the diagnosis.

The visual stream is more visually biased. Adequate semantic recognitionabilities are essential for normal reading. Hence the auditory inputregime will be the supplementary to the visual treatment. These willrequire oral, visual or kinaesthetic responses (writing or drawing). Forthe visual stream, the auditory inputs will not have their temporalcharacteristics modified digitally as is required for those that arephonologically impaired. The oral or kinaesthetic inputs will beintensified if the disorder profile indicates the need.

The phonological stream is more phonologically biased. Adequateoculomotor and stereopsis is essential for normal reading. Hence avisual treatment regime is supplementary to the phonological treatmentregime, incorporating less visually intensive parameters.

The connection between writing and visual or auditory memory is wellknown. Throughout treatment according to this invention, whether it beby the visually or phonologically biased treatment streams, the patientis required to write or draw words and phrases, by means of the stylusand work pad. The degree to which the treatment requires writing isdetermined by the patient's initial debilitation profile.

A large area of the brain is allotted to the sense of touch, withnumerous interconnections that include the visual and auditory systems.Although all the functional consequences of somatosensory debilitationson the visual and auditory systems are not known to the inventor,abnormally slow speed threshold differences in somatosensory functionscan be found when patients also exhibit slow speed threshold processingabnormalities in either the visual or auditory processing areas.

Part of the debilitation profile that is prepared according to thepresent invention, will include a somatosensory threshold speedassessment. Should the profile warrant it, a segment of the treatmentwill be dedicated to a somatosensory stimulation regime via a regulatedthreshold speed monitoring device that will be integrated with a visualstimulation regime, as well as with visual and auditory cognitive tasks.

An inventive aspect of the present invention is that it can providelinearly moving stimulation elements. This is important as manyneurophysiological processes such as reading have an inherently linearnature due to the usual display of text.

The present invention is well suited to make use of existingdevelopments in non-invasive techniques for measuring brain activitysuch as functional Magnetic Resonance Imaging (fTMRI) and PositronEmission Tomography (PET). During a patient's treatment different brainresponses can be monitored and provided to the computer processor. Thecomputer processor may then track which stimulation images and cognitiveexertion exercises generate the highest levels of brain activity andensure that these images and exercises are enhanced during a patient'streatment. This aspect of the invention can therefore assist indeveloping a specific treatment profile for a particular patient tooptimise the patient's treatment. The optimisatioti may be performedautomatically by the software that controls the display acting onfeedback from the brain monitoring, or by the therapist. Brain activitymonitoring can also be used to develop new stimulation images andcognitive exertion exercises that will be of benefit to the patient. Theapparatus required for brain activity monitoring can be incorporatedinto the headwear used for providing the display to the patient asdescribed previously with reference to FIG. 14.

The above described treatment methods apart from being able to treatreading disorders such as dyslexia, and writing and speech disorders,also has application in the treatment of Attention Deficit HyperactivityDisorder (ADHD). Research has shown that people suffering ADHD havesimilar neurophysiological debilitations as described for the presentinvention. Therefore the multi-sensory treatments described according tothe present invention are capable of rehabilitating ADHD sufferers.Hence the present invention offers the possibility of a longer term curefor ADHD without the social and medical problems that a drug basedtreatment can cause.

A further application of the present invention is in the enhancement ofthe neurophysiological process, in particular movement perception, inpeople who do not suffer from a visual disorder. Such people may forexample be sportspeople looking to enhance their sporting abilities ordefence personnel where good visual perception may at times be anecessary survival skill. For these treatments specific stimulationimages and cognitive exertion exercises may be generated. For example,the treatment may make use of existing virtual reality technology tocreate a cognitive exertion exercise where a sportsperson is presentedwith a realistic sporting situation such as a baseball batter receivinga pitch. The apparatus may also include as part of the virtual display abaseball bat that the patient wields to receive the pitch, the exercisebeing to make properly timed contact with the virtual ball. The virtualreality display would also include moving stimulation display elementsas discussed above for the passive enhancement of the receptive cellfields of the patient's visual pathways.

In a defence context, the virtual stimulation images may use specificcolours that enhance a person's ability to perceive movement in acamouflage environment.

Further application of the present invention will be apparent to theskilled reader.

While particular embodiments of this invention have been described, itwill be evident to those skilled in the art that the present inventionmay be embodied in other specific forms without departing from theessential characteristics thereof. The present embodiments and examplesare therefore to be considered in all respects as illustrative and notrestrictive, the scope of the invention being indicated by the appendedclaims rather than the foregoing description, and all changes which comewithin the meaning and range of equivalency of the claims are thereforeintended to be embraced therein.

1. Apparatus for the enhancement of neurophysiological processes of apatient including first visual display means for viewing by said patientand computer processing means producing an output to said visual displaymeans to cause a display on said display means, said display includingat least one visual cognitive exertion exercise and at least one visualstimulation image including a plurality of moving visual displayelements, wherein said visual stimulation image is capable of providingvisual stimulation to a patient whilst said patient is performing saidcognitive exertion exercise.
 2. Apparatus according to claim 1 furtherincluding second visual display means to be viewed by a therapist andtherapist input means allowing said therapist to provide inputs to saidprocessing means to vary said display.
 3. Apparatus according to claim 2wherein said therapist inputs vary at least one visual stimulation imagewhilst said patient is performing a displayed cognitive exertionexercise.
 4. Apparatus according to claim 2 wherein said therapistinputs vary at least one of the spatial density, luminance, contrast,colour, shape, velocity or locus of movement of one or more of saidmoving visual display elements.
 5. Apparatus according to claim 2further including feedback means providing an indication of saidpatient's performance to said computer processing means, and means forindicating said performance on said second visual display means. 6.Apparatus according to claim 5 wherein said feedback means includespatient input means allowing said patient to provide a response to saidcognitive exertion exercise.
 7. Apparatus according to claim 6 whereinsaid patient response is auditory.
 8. Apparatus according to claim 6wherein said patient response is written.
 9. Apparatus according to anyone of claims 6 to 8 further including means for varying said display inresponse to feedback from said patient.
 10. Apparatus according to claim5 wherein said feedback means includes means for monitoring brainactivity of said patient to measure a response to a visual stimulationimage and/or a cognitive exertion exercise.
 11. Apparatus according toclaim 10 further including means for varying said display to optimisesaid patient's brain response.
 12. Apparatus according to claim 11wherein said variations to said display are made by said computerprocessing means without input from said therapist.
 13. Apparatusaccording to claim 1 further including means for controlling saidpatient's position relative to said first visual display means. 14.Apparatus according to claim 13 wherein said means for controlling saidpatient's position includes an electronically controllable seat capableof moving up, down and laterally, an electronically controllablebackrest and an electronically controllable headrest.
 15. Apparatusaccording to claim 1 further including means to provide a differentdisplay to each eye of said patient.
 16. Apparatus according to claim 1or 15 wherein said first visual display means are virtual realitygoggles.
 17. Apparatus according to claim 1 or 2 wherein said computerprocessing means stores a plurality of visual cognitive exertionexercises.
 18. Apparatus according to claim 17 further including patientinput means, said output to said display means causing a differentcognitive exertion exercise to be displayed in response to an input fromsaid patient through said patient input means.
 19. Apparatus accordingto claim 1 wherein said visual stimulation image includes a plurality ofdots and annuli.
 20. Apparatus according to claim 19 wherein said visualstimulation image includes a dot surrounded by a contrasting annulus.21. Apparatus according to claim 19 or 20 wherein said visualstimulation image provides stimulation to concentrically organisedreceptive cell fields of a patient.
 22. Apparatus according to claim 1wherein said moving visual display elements include a plurality ofparallel stripes having a substantially linear component of movement.23. Apparatus according to claim 1 wherein said moving visual displayelements include a first plane of parallel stripes rotating relative toa second plane of parallel stripes.
 24. Apparatus according to claim 1wherein said moving visual display elements include a brick pattern. 25.Apparatus according to any one of claims 22 to 24 wherein said movingvisual display elements provide stimulation to the visual cortex of saidpatient.
 26. Apparatus according to claim 1 wherein said visual displayimage includes cortical stimulation elements and non-corticalstimulation elements.
 27. Apparatus according to claim 1 wherein atleast one of said moving visual display elements moves to at leastpartially obscure a displayed cognitive exertion exercise.
 28. Apparatusfor the enhancement of neurophysiological processes of a patientincluding First visual display means for viewing by said patient andcomputer processing means producing an output to said visual displaymeans to cause a display on said display means, said display includingat least one visual cognitive exertion exercise and at least one visualstimulation image including a plurality of moving visual displayelements, wherein said visual stimulation image is capable of providingvisual stimulation to a patient whilst said patient is performing saidcognitive exertion exercise and wherein said apparatus includes meansfor varying at least one of spatial density, luminance, contrast,colour, shape, velocity, orientation, direction of motion and locus ofmovement of said plurality of visual display elements.
 29. Apparatusaccording to claim 28 including means for varying at least two ofspatial density, luminance, contrast, colour, shape, velocity,orientation, direction of motion and locus of movement of said pluralityof visual display elements.
 30. Apparatus for the enhancement ofneurophysiological pathways of a patient including first visual displaymeans for viewing by said patient and computer processing meansproducing an output to said visual display means to cause a display onsaid display means, said display including at least one visual cognitiveexertion exercise and at least one visual stimulation image including aplurality of moving visual display elements, wherein said visualstimulation image is capable of providing visual stimulation to apatient whilst said patient is performing said cognitive exertionexercise and wherein said at least one cognitive exertion exerciseincludes a series of successive computer activated prompts requiring apatient response, said apparatus further including input means for apatient to input a response to said prompts.
 31. Apparatus for theenhancement of neurophysiological pathways of a patient including firstvisual display means for viewing by said patient and computer processingmeans producing an output to said visual display means to cause adisplay on said display means, said display including at least onevisual cognitive exertion exercise and at least one visual stimulationimage including a plurality of moving visual display elements moving ina substantially linear path, wherein said visual stimulation image iscapable of providing visual stimulation to a patient whilst said patientis performing said cognitive exertion exercise.
 32. Apparatus accordingto claim 31 wherein said moving visual display elements are stripesmoving in a path at least partially transverse to their longitudinalaxis.
 33. Apparatus according to claim 31 wherein said moving visualdisplay elements include a dot surrounded by a contrasting annulus. 34.Apparatus according to claim 31 wherein said moving visual displayelements are a pattern of bricks.
 35. Apparatus according to any one ofclaims 31 to 34 wherein the locus of movement of said visual displayelements is periodically adjusted.
 36. Apparatus for the enhancement ofneurophysiological pathways of a patient including first visual displaymeans for viewing by said patient and computer processing meansproducing an output to said visual display means to cause a display onsaid display means, said display including at least one visual cognitiveexertion exercise and at least one visual stimulation image including aplurality of moving visual display elements, wherein said visualstimulation image is capable of providing visual stimulation to apatient whilst said patient is performing said cognitive exertionexercise, said apparatus farther including means for generating anauditory cognitive exertion exercise including one or more auditorysignals related to at least one of said visual cognitive exertionexercises.
 37. Apparatus according to claim 36 wherein said auditorycognitive exertion exercise is related to a visual cognitive exertionexercise displayed on said first visual display means and requires saidpatient to focus on said related visual cognitive exercise. 38.Apparatus according to claim 36 or 37 wherein said auditory signals arecomputer generated speech signals.
 39. Apparatus according to claim 38wherein said speech signals are acoustically modified by said computerprocessing means such that the temporal portion of said speech isadjusted but the spectral portion of said speech remains substantiallyconstant.
 40. Apparatus according to claim 39 wherein said auditorysignals are modified in response to input from a therapist. 41.Apparatus according to claim 36 further including means to receive aspoken input from said patient.
 42. Apparatus for the enhancement ofneurophysiological pathways of a patient including first visual displaymeans for viewing by said patient, computer processing means producingan output to said visual display means to cause a display on saiddisplay means and patient input means, said display includingsuccessively displayed patient-interactive visual cognitive exertionexercises and at least one visual stimulation image including aplurality of moving visual display elements, wherein said visualstimulation image is capable of providing visual stimulation to apatient whilst said patient is performing a displayed cognitive exertionexercise and wherein a next cognitive exertion exercise is displayed inresponse to an input from said patient.
 43. A method of enhancingneurophysiological processes of a patient including the steps ofgenerating an output from computer processing means to cause a displayon visual display means for viewing by said patient, said displayincluding at least one visual cognitive exertion exercise and at leastone visual stimulation image including a plurality of moving visualdisplay elements, wherein said visual stimulation image provides visualstimulation to said patient whilst said patient is performing saidvisual cognitive exertion exercise.
 44. A method according to claim 43including the steps of receiving input from a therapist to vary saiddisplay and varying said display in response to said input.
 45. A methodaccording to claim 44 wherein the step of varying said display includes.The step of varying a visual stimulation image and is performed whilstsaid patient is performing a displayed cognitive exertion exercise. 46.A method according to claim 45 wherein the step of varying a visualstimulation image includes the step of varying at least one of thespatial density, luminance, contrast, colour, shape, velocity,orientation, direction of motion and locus of movement of said pluralityof visual display elements.
 47. A method according to claim 43 furtherincluding the step of varying the display in response to feedbackreceived from said patient.
 48. A method according to claim 43 furtherincluding the step of receiving at said computer processing meansfeedback representing said patient's brain activity.
 49. A methodaccording to claim 48 further including the step of varying said displayto optimise said patient's brain activity.
 50. A method according toclaim 43 further including the step of providing a different display toeach eye of said patient.
 51. A method according to claim 43 whereinsaid visual stimulation image includes a plurality of dots and annuli.52. A method according to claim 51 wherein said visual stimulation imageincludes a dot surrounded by a contrasting annulus.
 53. A methodaccording to claim 51 or 52 wherein said visual stimulation imageprovides stimulation to concentrically organised receptive cell fieldsof a patient.
 54. A method according to claim 43 wherein said movingvisual display elements include a plurality of parallel stripes having asubstantially linear component of movement.
 55. A method according toclaim 43 wherein said moving visual display elements include a firstplane of parallel stripes rotating relative to a second plane ofparallel stripes.
 56. A method according to claim 43 wherein said movingvisual display elements include a brick pattern.
 57. A method accordingto any one of claims 54 to 56 wherein said moving visual displayelements provide stimulation to the visual cortex of said patient.
 58. Amethod according to claim 43 wherein said visual display image includescortical stimulation elements and non-cortical stimulation elements. 59.A method according to claim 43 wherein at least one of said movingvisual display elements moves to at least partially obscure a displayedcognitive exertion exercise.
 60. A method according to claim 43 furtherincluding the step of moving said visual display elements in asubstantially linear path.
 61. A method according to claim 60 includingthe step of periodically adjusting the locus of movement of said visualdisplay elements.
 62. A method according to claim 43 further includingthe step of providing to said patient an auditory cognitive exertionexercise related to said visual cognitive exertion exercise.
 63. Amethod according to claim 43 wherein said method is used in thetreatment of disorders of at least one of reading, writing or speech.64. A method according to claim 63 wherein said method is used in thetreatment of visual dyslexia.
 65. A method according to claim 43 whereinsaid method is used in the treatment of Attention Deficit HyperactivityDisorder.